Treatment for ADHD: Many children may be failing

A cross-sectional study suggests that many children with attention-deficit hyperactivity disorder (ADHD) may not be getting the treatment they need.

Of the 1,206 children whose parents reported ADHD, only 26.2% had received some form of outpatient mental health care, says Mark Olufson, M.D., Ph.D., of Columbia University and the New York State Psychiatric Institute in New York City. , Master of Public Health, and colleagues reported.

Additionally, only 12.9% of children were currently taking ADHD medication. Eight percent received stimulants and 5.1% received atomoxetine (Strattera), guanfacine, or clonidine. JAMA network open.

“These ADHD treatment rates are CDC report Most ADHD children receive treatment,” write Olfson and the team. However, the difference is that Orffson’s group only looked at her parent-reported ADHD, whereas the CDC figures were based on children with her clinical diagnosis of ADHD.

“It would be too simplistic to assume that all children with parent-reported ADHD will require or benefit from treatment,” they added, noting that parental reporting is an alternative to formal clinical evaluation. However, they explained, these figures suggest that a significant number of children with suspected ADHD may be going through the cracks.

“Since most U.S. children are screened annually, an opportunity exists to improve ADHD detection in primary care,” they wrote. “However, because no screening tool is sufficiently accurate to be used alone, primary care clinicians must consider multiple informants when evaluating children for ADHD.” A local shortage of mental health clinicians also hinders access to care in many communities.”

To more accurately identify children with ADHD whose treatment may be overlooked, Olfson’s group identified specific groups who were lagging behind in substance use and mental health care.

For example, significantly more boys than girls were prescribed ADHD medication (15.7% vs. 7%). “A common explanation for this gender-based difference is that boys are more likely to be referred for evaluation because they tend to have more disruptive clinical symptoms than girls,” the group noted. bottom.

Additionally, white children were more likely than black children to write scripts (14.8% vs. 9.4%). Orffsson and team noted that black children were particularly less likely to take stimulants, and that the discrepancies in dosing rates were less evident with non-stimulants.

“Contrary to our expectations,” the researchers wrote. Children whose parents have only high school education are more likely to be prescribed ADHD medications compared to parents with bachelor’s degrees or higher (32.2% vs. 11.5%). Furthermore, the proportion of children with ADHD who received mental health care was higher in lower-income households.

• Under $25,000: 36.5%
• $25,000 to $49,999: 27.7%
• $75,000 or more: 20.1%

With respect to ADHD subtypes, children with mixed subtypes received more medication or mental health care than children with inattentive or hyperactive-impulsive subtypes.

“The findings provide a sense of the size and distribution of untreated children with parent-reported ADHD,” Orffsson and colleagues wrote. It underscores the importance of developing strategies to increase access to immunization and acceptable treatment.”

The group used cross-sectional survey data from the Adolescent Brain and Cognitive Development Study and identified 1,206 children aged 9 and 10 years. DSM-5 Criteria for ADHD Based on parent reports. Of this group, 68.2% were boys and 62.2% were white.

Far more children with parent-reported ADHD had disruptive behavior disorders, anxiety disorders, obsessive-compulsive disorders, or mood disorders.

Orffson and team noted that medication evaluations were based on parent reports with no confirmatory administrative or prescribing data.